Scielo RSS <![CDATA[African Journal of Laboratory Medicine]]> http://www.scielo.org.za/rss.php?pid=2225-201020220001&lang=en vol. 11 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Beta-lactamase resistance genes in <i>Enterobacteriaceae</i> from Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Beta-lactamase genes are one of the most important groups of antimicrobial resistance genes in human and animal health. Therefore, continuous surveillance of this group of resistance genes is needed for a better understanding of the local epidemiology within a country and global disseminationAIM: This review was carried out to identify different beta-lactamase resistance genes reported in published literature from NigeriaMETHODS: Systematic review and meta-analysis was carried out on eligible Nigerian articles retrieved from electronic literature searches of PubMed®, African Journals Online, and Google Scholar published between January 1990 and December 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was adopted to facilitate clarity and transparency in reporting review findingsRESULTS: Fifty-seven articles were included. All beta-lactamases reported were detected from Gram-negative bacteria, particularly from Enterobacteriaceae. Thirty-six different beta-lactamase genes were reported in Nigeria. These genes belong to the narrow-spectrum, AmpC, extended-spectrum and carbapenemase beta-lactamase resistance genes. The pooled proportion estimate of extended-spectrum beta-lactamase genes in Nigeria was 31% (95% confidence interval [CI]: 26% - 36%, p < 0.0001), while the estimate of the blaCTX-M-15 gene in Nigeria was 46% (95% CI: 36% - 57%, p < 0.0001). The proportion estimate of AmpC genes was 32% (95% CI: 11% - 52%, p < 0.001), while the estimate for carbapenemases was 8% (95% CI: 5% - 12%, p < 0.001CONCLUSION: This study provides information on beta-lactamase distribution in Nigeria. This is necessary for a better understanding of molecular epidemiology of clinically important beta-lactamases, especially the extended-spectrum beta-lactamases and carbapenemases in Nigeria <![CDATA[<b>Extranodal presentation of a lymphoma with precursor B-cell phenotype and translocation t(8;14) in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100002&lng=en&nrm=iso&tlng=en INTRODUCTION: A rare entity of a B-cell malignancy with precursor B-cell phenotype and concomitant translocation t(8;14) or variant MYC translocation exists. These cases show clinical, pathological and molecular overlap between precursor B-lymphoblastic leukaemia or lymphoma and Burkitt leukaemia or lymphoma (BLLCASE PRESENTATION: We report a case from February 2019 at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa, of a 9-month-old infant with a predominantly extracranial soft tissue mass showing extradural extension. There was no involvement of the peripheral blood or bone marrow. Fine needle aspiration and Tru-Cut biopsy of the soft tissue scalp mass showed the tumour to be of precursor B-cell phenotype. Contrastingly, an immunophenotypic assessment revealed a high S-phase fraction and raised concern for BLL. This prompted testing for the translocation t(8;14) by fluorescence in-situ hybridisation analysis, which confirmed this aberrationMANAGEMENT AND OUTCOME: Based on the published experience of other centres, the patient was initiated on a BLL protocol. Despite an excellent clinical response, the patient succumbed to neutropenic sepsis six months after diagnosis.CONCLUSION: Leukaemia or lymphoma with translocation t(8;14) or variant MYC translocation and precursor B-cell phenotype is a rare entity with a varied clinical presentation. This poses a challenge for diagnosis and classification and a clinical dilemma for the choice of treatment <![CDATA[<b>Retrospective analysis of Vitek®2 performance compared to manual broth micro-dilution for colistin susceptibility testing of <i>Acinetobacter baumannii</i>complex isolates in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100003&lng=en&nrm=iso&tlng=en The manual broth micro-dilution (mBMD) is the recommended reference method for colistin minimum inhibitory concentration determination; however, it is not as readily available in South Africa as the Vitek®2. This retrospective study compared the performance of Vitek®2 against mBMD in determining the colistin minimum inhibitory concentration of 337 extensively drug-resistant Acinetobacter baumannii complex isolates. Vitek®2 yielded a categorical agreement of 89%, an essential agreement of 56%, a major error rate of 8% and a very major error rate of 55%. The Vitek®2 is not an alternative to mBMD for colistin susceptibility testing. <![CDATA[<b>Microbiology laboratories involved in disease and antimicrobial resistance surveillance: Strengths and challenges of the central African states</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100004&lng=en&nrm=iso&tlng=en Laboratory systems have been largely neglected on the margins of health systems in Africa. However, since the 2000s, many African countries have benefited from massive investments to strengthen laboratory capacities through projects fighting priority diseases (HIV/AIDS, tuberculosis, malaria). This review examined the laboratory capacities of the Economic Community of Central African States (ECCAS). Online research using specific terms was carried out. Studies published between 2000 and 2021 on the role of the laboratory in disease and antimicrobial resistance surveillance in the 11 ECCAS countries were considered. The number of human and animal health laboratories meeting international standards was very low in the sub-region. There were only seven International Organization for Standardization (ISO) 15189-accredited human health laboratories, with five in Cameroon and two in Rwanda. There were five high biosafety level (BSL) laboratories (one BSL3 laboratory each in Cameroon, the Central African Republic, Democratic Republic of Congo and the Republic of Congo, and one BSL4 laboratory in Gabon) and three ISO 17025-accredited laboratories in the ECCAS sub-region. Only six countries currently have whole-genome sequencing devices, which is insufficient for a sub-region as large and populous as ECCAS. Yet, a plethora of pathogens, particularly haemorrhagic viruses, are endemic in these countries. The need for laboratory capacity strengthening following a One Health approach is imperative. Since emerging and re-emerging zoonotic infectious diseases are projected to triple in frequency over the next 50 years and given the inextricable link between human and animal health, actors in the two health sectors must collaborate to preserve world health. <![CDATA[<b>Impact of pre-COVID-19 epidemic preparedness on the trajectory of the pandemic in African countries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100005&lng=en&nrm=iso&tlng=en BACKGROUND: The novel coronavirus disease 2019 (COVID-19), declared a pandemic by the World Health Organization (WHO) in March 2020, has taught us about the importance of epidemic preparedness. OBJECTIVE: We analysed the pre-COVID-19 preparedness of sub-Saharan African countries and how this may have influenced the trajectory of COVID-19 cases. METHODS: The WHO Joint External Evaluation (JEE) tool and the Global Health Security (GHS) Index were used to determine the epidemic preparedness of countries in the WHO African Region. The relationship between pre-COVID-19 preparedness and the reported number of cases per million people was evaluated over the first 120 days of the first reported case in each country, between February 2020 and September 2020. RESULTS: The overall performance of the 42 countries was 40% in the 19 JEE core capacities and 32% in the six GHS Index indicators. At Day 1, the mean number of cases per million population was significantly higher among countries rated as 'prepared' in the JEE legislation, policy and finance (p = 0.03), ports of entry (p = 0.001), and international health regulation coordination, communication and advocacy (p = 0.03) categories. At Day 90, countries rated as 'prepared' in the national laboratory systems (p = 0.05) and real-time surveillance (p = 0.04) JEE categories had statistically significantly fewer cases per million population. CONCLUSION: This analysis highlights the importance of building capacity for pandemic preparedness in Africa. The WHO African Region was not adequately prepared for the COVID-19 pandemic as measured by the WHO JEE tool and the GHS Index. <![CDATA[<b>Corrigendum: Higher proportion of non-classical and intermediate monocytes in newly diagnosed multiple myeloma patients in Egypt: A possible prognostic marker</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100006&lng=en&nrm=iso&tlng=en BACKGROUND: The novel coronavirus disease 2019 (COVID-19), declared a pandemic by the World Health Organization (WHO) in March 2020, has taught us about the importance of epidemic preparedness. OBJECTIVE: We analysed the pre-COVID-19 preparedness of sub-Saharan African countries and how this may have influenced the trajectory of COVID-19 cases. METHODS: The WHO Joint External Evaluation (JEE) tool and the Global Health Security (GHS) Index were used to determine the epidemic preparedness of countries in the WHO African Region. The relationship between pre-COVID-19 preparedness and the reported number of cases per million people was evaluated over the first 120 days of the first reported case in each country, between February 2020 and September 2020. RESULTS: The overall performance of the 42 countries was 40% in the 19 JEE core capacities and 32% in the six GHS Index indicators. At Day 1, the mean number of cases per million population was significantly higher among countries rated as 'prepared' in the JEE legislation, policy and finance (p = 0.03), ports of entry (p = 0.001), and international health regulation coordination, communication and advocacy (p = 0.03) categories. At Day 90, countries rated as 'prepared' in the national laboratory systems (p = 0.05) and real-time surveillance (p = 0.04) JEE categories had statistically significantly fewer cases per million population. CONCLUSION: This analysis highlights the importance of building capacity for pandemic preparedness in Africa. The WHO African Region was not adequately prepared for the COVID-19 pandemic as measured by the WHO JEE tool and the GHS Index. <![CDATA[<b>Challenges and complexities in evaluating severe acute respiratory syndrome coronavirus 2 molecular diagnostics during the COVID-19 pandemic</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100007&lng=en&nrm=iso&tlng=en BACKGROUND: The novel coronavirus disease 2019 (COVID-19), declared a pandemic by the World Health Organization (WHO) in March 2020, has taught us about the importance of epidemic preparedness. OBJECTIVE: We analysed the pre-COVID-19 preparedness of sub-Saharan African countries and how this may have influenced the trajectory of COVID-19 cases. METHODS: The WHO Joint External Evaluation (JEE) tool and the Global Health Security (GHS) Index were used to determine the epidemic preparedness of countries in the WHO African Region. The relationship between pre-COVID-19 preparedness and the reported number of cases per million people was evaluated over the first 120 days of the first reported case in each country, between February 2020 and September 2020. RESULTS: The overall performance of the 42 countries was 40% in the 19 JEE core capacities and 32% in the six GHS Index indicators. At Day 1, the mean number of cases per million population was significantly higher among countries rated as 'prepared' in the JEE legislation, policy and finance (p = 0.03), ports of entry (p = 0.001), and international health regulation coordination, communication and advocacy (p = 0.03) categories. At Day 90, countries rated as 'prepared' in the national laboratory systems (p = 0.05) and real-time surveillance (p = 0.04) JEE categories had statistically significantly fewer cases per million population. CONCLUSION: This analysis highlights the importance of building capacity for pandemic preparedness in Africa. The WHO African Region was not adequately prepared for the COVID-19 pandemic as measured by the WHO JEE tool and the GHS Index. <![CDATA[<b>Prevalence of alpha and beta haemolysin among blood group O donors in Bamenda, Cameroon</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100008&lng=en&nrm=iso&tlng=en BACKGROUND: The occurrence of high titres of alpha (anti-A) and beta (anti-B) haemolysin immunoglobulin G antibodies in blood causes haemolysis during blood transfusion from a group O donor, commonly and inappropriately known as the 'universal blood donor', to a group A, B or AB recipient. Surprisingly, haemolysin testing is not routinely done during blood transfusion services in Bamenda, Cameroon OBJECTIVE: This study aimed to determine the prevalence of haemolysin among blood group 'O' donors at the Regional Hospital Bamenda Blood Bank, Bamenda, Cameroon METHODS: This was a cross-sectional descriptive study carried out between June and September 2020 at the Regional Hospital Bamenda Blood Bank, Bamenda, Cameroon. Blood group O donors who were free from transfusion-transmissible infections were selected systematically and serially and their serum tested for the presence of haemolysin. Haemolysin titres were determined, and titres ≥ 8 were considered significant. The associations between haemolysin prevalence and age group, gender and Rhesus D blood group were determined using the chi-square test RESULTS: The prevalence of haemolysin among the 480 study participants was 52.1% and significant haemolysin titres were detected in 18.5%. There was no association between haemolysin and gender, age group or the Rhesus D blood group CONCLUSION: The prevalence of significant titres of haemolysin among participants in this study was high. There is the need to test for haemolysin in blood group O donors to prevent the potential risk to blood group A, B, and AB recipients and to provide safer blood for transfusion <![CDATA[<b>Red cell distribution width as a surrogate marker of haemoglobinopathies in western Kenya</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100009&lng=en&nrm=iso&tlng=en BACKGROUND: Haemoglobinopathies are inherited haemoglobin disorders that result in anaemia characterised by erythrocyte anisopoikilocytosis. Red cell distribution width (RDW) measures anisopoikiloytosis and is readily reported by haematology analysers as a complete blood count parameter. The utility of RDW as a diagnostic marker of haemoglobinopathies in Kenya remains undetermined and undocumented. OBJECTIVE: This study aimed to determine the diagnostic efficacy of RDW in discriminating haemoglobinopathy and haemoglobinopathy-free cases in Kenya. METHODS: The case-control study used randomly selected haematology analyser outputs for haemoglobinopathy-free (241, 49.4%) and haemoglobinopathy cases (247, 50.1%) aged 1 month to 66 years old tested in the Aga Khan Hospital, Kisumu, and its satellite centres in western Kenya from 01 January 2015 to 31 December 2020. Results were verified using high performance liquid chromatography. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic power of RDW as a biomarker for sickle cell disease (SCD) and sickle cell trait phenotypes and β-thalassaemia. RESULTS: The RDW showed diagnostic significance in SCD phenotypes at 21.1 ROC curve coordinate with 67.7% sensitivity, 90.0% specificity, 0.789 accuracy, 70.5% positive predictive validity, 88.8% negative predictive validity, 6.77 positive likelihood ratio, 0.36 negative likelihood ratio and 18.94 (11.4-31.4) odds ratio. CONCLUSION: An RDW of 21.1% is potentially a predictor of SCD haemoglobin phenotypes and should be included in the haematology screening algorithm as a critical value, above which suspected cases qualify to be investigated for SCD. <![CDATA[<b>Appropriate use of plasma glucose tests for diagnosis of diabetes mellitus in Ibadan, Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2225-20102022000100010&lng=en&nrm=iso&tlng=en BACKGROUND: Diabetes mellitus is a growing epidemic in Africa. Its diagnosis relies exclusively on laboratory evidence, which differs based on clinical circumstances. OBJECTIVE: The study described the appropriateness of plasma glucose test requests per the American Diabetes Association criteria. METHODS: We reviewed the plasma glucose test requests received by the chemical pathology laboratory of the University College Hospital, Ibadan, Nigeria between June 2018 and November 2018. The American Diabetes Association diabetes diagnostic criteria were used to define the appropriateness of test requests and determine the potential for ill-informed clinical decisions. RESULTS: Four hundred and twenty-three requisition forms were included, with the majority from the medical wards/clinics (72.3%); the most frequent reason for a plasma glucose test was systemic hypertension (28.6%). Fasting plasma glucose was most requested (254; 60.0%). One hundred and sixteen (27.4%) requests were potentially inappropriate, with the 2-h postprandial plasma glucose (2hPPG) test requests (83; 71.6%) being the most inappropriate. The difference in the proportion of inappropriate requests was not statistically significantly between medical or surgical wards/clinics (Odds ratio 1.131, 95% confidence interval 0.709-1.803, p = 0.605). Inappropriate requests in six cases may have triggered inappropriate action. CONCLUSION: A third of the glucose tests requested for querying diabetes mellitus may have been inappropriate. Results of such testing may trigger inappropriate clinical action. To improve the quality of care and for economic reasons, laboratories should have programmes to improve the appropriate use of their services.